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Yoga Retreat registration form
In consideration of my being permitted to participate in Hatha Yoga activities, I, for myself, my heirs, legal representatives, and assigns, do hereby release said activity, the activity instructor, Subhash Mittal, and any person responsible for organizing and/or overseeing the activity at the location where the said activity will be conducted, from all suits, claims or demands of any kind, which may result from any injury, loss or damage of any kind, arising out of or in connection with my participation in said activity.

Please fill out as much information as possible in all the fields below. More detailed information will help me help you in your yoga practice.

Your Name (First, Last)
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Work Phone
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Home/Mobile Phone
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Email address
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Profession/Place of Work
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What benefits do you expect to realize from your yoga practice?
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Previous Yoga Experience - Style, Duration etc
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Any other sporting or physical activity that you participate in
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Any medical condition that we should know about (include surgeries or serious illnesses in the past)
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